性别差异对自身免疫性肝炎患者临床特征及预后的影响  

Clinical features and prognosis of autoimmune hepatitis patients with different sexes

作　　者：伍慧丽 时红波[2] 刘燕敏[3] 丁美[4] 马正来 刘霜[4] 陈煜 段钟平 WU Huili;SHI Hongbo;LIU Yanmin;DING Mei;MA Zhenglai;LIU Shuang;CHEN Yu;DUAN Zhongping(Intractable Hepatic Diseases and Artificial Liver Treatment&Training Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Institute of Hepatology,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Department of Immunopathy and Hepatology,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院疑难肝病及人工肝中心,北京100069 [2]首都医科大学附属北京佑安医院肝病研究所,北京100069 [3]首都医科大学附属北京佑安医院肝病免疫科,北京100069 [4]首都医科大学附属北京佑安医院肝衰竭与人工肝治疗研究北京市重点实验室,北京100069

出　　处：《临床肝胆病杂志》2021年第7期1636-1643,共8页Journal of Clinical Hepatology

基　　金：国家重点研发计划资助(2017YFA0103000);国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2012ZX10002004-006,2017ZX10203201-005,2017ZX10201201-001-001,2017ZX10201201-002-002,2017ZX10201201-004-002,2017ZX10202203-006-001,2017ZX10302201-004-002);北京市医院管理局“登峰”人才培养计划基金资助项目(DFL20151601);北京市医院管理局临床医学发展专项经费资助(ZYLX201806);科技创新服务能力建设-高精尖学科建设项目(市级)(11920703);首都医科大学重点实验室开放研究课题(BJYAHKF2017008)。

摘　　要：目的自身免疫性肝炎(AIH)主要发生在女性,目前对男性AIH患者的研究甚少,本研究比较不同性别AIH之间的临床差异。方法收集2009年10月—2019年10月在北京佑安医院住院并确诊为AIH的患者398例进行回顾性研究,分为男(n=48)、女(n=350)两组,对一般情况、临床特点及预后等影响因素进行分析。主要研究终点为死亡或肝移植治疗。正态分布的计量资料2组间比较采用t检验,非正态分布计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ^(2)检验或Fisher精确概率法。采用Cox比例风险模型进行单变量和多变量分析。结果年龄方面,51-60岁是两组的发病高峰,但是男性在21-30岁时段确诊率明显高于女性(8/48 vs 24/334,χ^(2)=4.915,P=0.027),而在41-50岁时段则低于女性(7/48 vs 97/334,χ^(2)=4.428,P=0.035)。AIH分类方面,男性特发性AIH占比更高(31/48 vs 170/350,χ^(2)=4.329,P=0.037),但男性合并其他自身免疫性疾病尤其是甲状腺功能亢进比例低于女性(0/48 vs 39/348,P=0.008)。实验室检查方面,男性ANA≥1∶100(42/48 vs 325/340,χ^(2)=5.375,P=0.020)和SSA/SSB(2/48 vs 76/340,χ^(2)=7.566,P=0.006)阳性率显著低于女性患者;男性ANA≥1∶1000的比率显著低于女性(P<0.0001)。预后方面,男性出现死亡或接受肝移植的年龄要远小于女性[(31.5±15.9)岁vs(53.9±12.6)岁,t=3.798,P=0.001],男性失代偿期肝硬化及肝细胞癌发生更多见(P值均<0.05)。与生存期下降有关的高危因素,男性:糖尿病、肝硬化以及血Alb<31.4 g/L,女性:肝衰竭、肝硬化、ANA≥1∶1000、DBil>42μmol/L、淋巴细胞计数<1.2×10^(9)/L以及补体C3<0.588 g/L(P值均<0.05)。结论性别差异对AIH患者临床表现和预后有一定影响,主要表现在男性患者更年轻、预后更差。Objective To investigate the differences between autoimmune hepatitis(AIH)patients with different sexes,since AIH is more common in female individuals and there are few studies on male AIH patients.Methods A retrospective analysis was performed for 398 patients who were hospitalized in Beijing YouAn Hospital from October 2009 to October 2019 and were diagnosed with AIH,and the patients were divided into female group and male group according to sex.General status,clinical features,and prognosis were analyzed.The primary outcome measure was death or liver transplantation.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.The Cox proportional hazards model was used to perform univariate and multivariate analyses.Results As for age,the peak of disease onset was observed in patients aged 51-60 years in both male and female groups,and compared with the female group,the male group had a significantly higher rate of confirmed diagnosis at the age of 21-30 years(8/48 vs 24/334,χ^(2)=4.915,P=0.027)and a significantly lower rate of confirmed diagnosis at the age of 41-50 years(7/48 vs 97/334,χ^(2)=4.428,P=0.035).As for AIH,compared with the female group,the male group had a significantly higher proportion of patients with idiopathic AIH(31/48 vs 170/350,χ^(2)=4.329,P=0.037)and a significantly lower proportion of patients with other autoimmune diseases,especially hyperthyroidism(0/48 vs 39/348,P=0.008).As for laboratory examination,compared with the female group,the male group had significantly lower positive rates of anti-nuclear antibody(ANA)≥1∶100(42/48 vs 325/340,χ^(2)=5.375,P=0.020)and SSA/SSB(2/48 vs 76/340,χ^(2)=7.566,P=0.006),as well as a significantly lower proportion of patients with ANA≥1∶1000(P<0.0001).As for prognosis,compared with th

关 键 词：肝炎 自身免疫性 性别 体征和症状 预后 

分 类 号：R575[医药卫生—消化系统]